As President Obama has acknowledged, when we consider a response to the sporadic mass shootings events, we must acknowledge that all types of violence are related. Violence acts like a contagious disease: it spreads and can reach “epidemic” levels. Advancements in neuroscience, behavioral science and epidemiology give us a new understanding of how violence is transmitted—and how a public-health approach can stop it.

What is a “public-health approach” to violence?

The public health community uses science-based strategies to treat contagious diseases and epidemics, like AIDS and tuberculosis. Those same strategies can be applied to reducing shootings and killings; for example, the Cure Violence public health approach to violence has reduced shootings by up to 73 percent.

How can we apply the public-health approach across the country and stop violence?

It is vital that our nation’s violence prevention response include a response to the endemic (“everyday”) violence, as well as the sporadic (mass events). Both have devastating effects and impact our country’s cultural norms.

Provide training and resources for health agencies, non-profit organizations, and communities on the underlying causes of violence, enabling them to implement evidence-based public health strategies to reduce endemic community violence.

Public-health training should facilitate a coordinated system, not just “collaboration.” An example of such a system is health departments and hospitals trained to administer full public-health programs; emergency room workers trained on interacting with victims of violence (and friends who may retaliate), teachers and other school officials trained to identify high-risk individuals, and community organizations and community workers who can work with the highest risk to change their likelihood of using violence.

Training can be provided by a combination of the CDC, Unity and Cure Violence. Unity’s resources can be used for more comprehensive planning, while Cure Violence could guide the areas of detection, implementation, and behavior change.

The training would consist of comprehensive planning, direct intervention methods, behavior change methods, community involvement and public education. The implementation of the training would be coordinated with the local agencies involved, starting in a few cities with severe violence problems initially and then implementing nationwide over time.

RECOMMENDATION #2 – Public-health effort to identify and treat those at high risk for perpetrating mass shootings

The same approaches for treating endemic violence can also be applied to sporadic mass shooting events. Effective proactive detection and interruption is currently lacking—both of potential deadly events and of individuals who are at high risk for perpetrating these tragedies.

The public-health community refers to proactive detection as “active case finding,” which differs from “passive case finding” in that it does not rely solely on referrals, but instead actively seeks out cases that need attention. While every mass shooting tragedy results in stories after-the-fact of warning signs, nobody is currently tasked with detecting these warning signs and putting an effective response into action.

These troubled and usually isolated individuals must be detected and successfully interacted with before they are able to act violently. There are many examples in health and epidemic control of ways to do this that are beyond what mental health services provide. This can also be done wrong—in other words with counterproductive consequences.

A proactive and well-designed public-health effort to detect these potential events and individuals would include the provision of highly specific training —as well as resources to community health departments and schools—to enable active case finding and effective treatment.

To realize immediate impacts in community violence, the federal government could choose to replicate an existing public-health program to address violence in several of the most violent cities in the country. The Cure Violence program is one example of an effective public-health approach.

The cost of a fully implemented public health program in 15 of the cities with the highest homicide rates would be approximately $150 to $200 million. Given that each shooting carries a societal cost of approximately $1 million, a conservative estimate of a 30 percent reduction in shootings and killings in these cities would yield a total cost savings of about $800 million in the first year.